|
|
| |
Forum Overview
::
We Love Katamari
|
| |
|
by saltlord 06/24/2020, 2:24pm PDT |
|
 |
|
 |
|
blackwater wrote:
saltlord wrote:
The difference between a chinese liver and a russian one, or between my brain and yours, are all potential facts according to academics. It's of interest to prescribers what your metabolism's gonna do and if it can be predicted in a way that saves people suffering on the wrong drugs, it should and policy should reflect it. With cheap testing. Like the pharmacogenomic testing I took.
Actually, there are already activists working on trying to stop hospitals from using race to give better medical treatment. A few weeks ago I found a twitter post from one of them bragging about causing some hospital or other to stop considering race when treating liver issues. Sorry, I can't find the link now.
Those activists are either dumb or obviously right on a case by case basis. I'm talking about a debate within the scientific community about complex genome interactions, not operational clinical practices. The science for that is still coming in and will be for a while. I've followed enough of it to know. However, at the end I pivoted rather abruptly to what IS currently possible: said testing.
saltlord wrote:
Not all doctors believe in the testing, but then some doctors are fucking cranks that believe prozac doesn't have side effects (my personal experience) or that they should marry their kids or whatever the fuck.
As I recall, Scott's position was that genetic testing wasn't that helpful when prescribing anti-depressants. I think the reason boiled down to the testing being only moderately accurate, and also expensive. Keep in mind that the alternative, just trying different courses of anti-depressants on a patient until one "clicks," is pretty easy to do.
Well, you unintentionally pushed my jeep button. Here we go.
It's easy to prescribe a few meds until one 'clicks' (not what they do, treating people is far less precise than building ikea shelves) in that it's easier than arguing with an insurer through paperwork, but this is what we call medical paternalism, which is just advocate language for doctors being shitty to patients because insurers, certifiers, boards, pharma, thought leaders, and the industry are shitty to patients. The shit rolls downhill, so they don't do the tests. By which we mean tell an admin to order them after having like one conversation with a PGx test sales guy and then charging their patient.
As for price - the comprehensive panel testing options I've seen are less than $200 over the counter (subsets for one condition are often less), and decidedly less than that for a medicaid patient whose insurer bargains down a provider, which is more than the $6 for a prozac script fill at walmart but far less than the cost of a malpractice or wrongful death suit when you fail to predict a suicide, which happens often enough to be a professional hazard of telling someone you'd rather they go through two to eight months per drug on one to six drugs in order of decreasing likelihood to work (this is the standard protocol, they actually do this to people whose families could sue in case of suicide). Smart doctors have realized the risk of this is serious enough to write their ER notes as if the patient has already died. Also you own the results forever and they apply to a lot more drugs than just what your shrink might write for. It's not like your genes are gonna change. It is a poor doctor who can neither do the cost/benefit on such a test nor sell one to a patient.
Accuracy is another question altogether. PGx tests are plenty accurate at predicting what you can metabolize, given your metabolism isn't in a dogshit state (for which refer patient to metabolic specialists and take thorough history), your drug-drug interactions aren't set up poorly (for which there are free tools provided to doctors to do regimen component comparisons that they often don't use because of time constraints, ignorance, inertia, favoritism, and in a few cases I've had the displeasure to observe, straight-up fucking laziness), and you're getting your knowledge of pharmaceutical compounds from a useful source (the pharmacist at every CVS has four years of school for this, nearly all MDs have six months, and pharma sales reps have a deck of power point slides).
Maybe Scott could be better at his job, though most MDs aren't going to need to be - 60% of depression cases likely respond to standard doses of prozac. Then there's the other 40%, and so on for other disorders. This is why medical advocates exist, but we're a weird breed. Also, all the information throughput doctors have is controlled by their work environments, which are plenty shitty, and mostly controlled by pharma and insurance and the law. Pharma does not fucking want you to fail to sell their new favorite compound because you have a procedure for finding an ideal, low-cost fit first. Pharma especially doesn't want you knowing what does and doesn't work for punching holes in their marketing and pays buckets of money to 'thought leaders' in clinical professions to make this happen even when it stands to get sued hard for it later; this last couple years they got hit for selling an AIDS drug that did kidney and bone damage and knowing about it when a safer alternative existed but who cares, prescribe Truvada until the cost of the recalls and lawsuits is comparable, Fight Club style. What they do to negotiate drug prices is largely out of sight and mind to doctors because it is negotiated with insurers - the clinicians I work with routinely don't know as much about per-dose cost as my pharmacy contacts do.
saltlord wrote:
The debate about policy needing to be driven by modern day genetic research is gonna go on long after they disprove the bell curve once and for all (now THAT'S racist shit). This guy had a dumb, premature notion - I'll wait until I have evidence to judge how it materially affected his patient-oriented behavior as a clinician.
Debate? There is no debate. If you breathe a word about genetic differences in IQ in public, you will lose your job and be cancelled. You're allowed to talk about genetic differences in liver function or whatever for now, but that may soon be unacceptable as well.
There is a huge amount of evidence for genetic variation in intelligence, but it certainly doesn't matter in the current political climate. What is in the process of happening is that we're going to stop doing any kind of standardized testing in order to sweep the gaps under the rug. The process started in the 1970s with Griggs v. Duke Power. It's going to finish soon with the end of the SATs, ACTs, for admissions to college.
Since you keep going off in this direction, it doesn't matter to me what the pop culture cranks out on twitter about race science, you're bringing this back to that instead of talking about the international medical community studying genetic factors in anatomical differences and that is far more interesting to me. Mostly because if I take Feynman's wife-beating ass down a peg by giving him blood pressure problems so bad he can't do his job or be gregarious, he cannot function in any fashion that is measurably intelligent without the right medication and that medication might be selected genetically. Everything else is whatever.
If you're bemoaning the end of college admissions, I'm perfectly fine with decommodifying education and forcing the work of sorting the wheat from the chaff back onto academic advisors and professors instead of letting them coast on tenure and fuck around while student selection is run by the college's marketing team. |
|
 |
|
 |
|
|
|
| |
Slate Star Codex probably going to be doxxed by the New York Times by Vested Id 06/23/2020, 12:11am PDT 
Why is that guy letting his profession be known? by Mysterio 06/23/2020, 5:50am PDT
Yeah, being a 100% Mysterio is the purest form of shitposting NT by Mysterio 06/23/2020, 6:15am PDT
it was a psychiatry blog by an MD from the start like the other one mentioned by saltlord 06/23/2020, 6:34am PDT
It wasn't really a psychiatry blog by Mysterio 06/23/2020, 8:12am PDT
Figures. Great work saltlord. NT by Mysterio 06/23/2020, 8:45am PDT
Pick a name you FUCKING COWARD. NT by N/A Ever 06/23/2020, 9:19am PDT
fag NT by fag NT 06/23/2020, 12:47pm PDT
He's not a "genteel racist" unless you're a fascist by Vested Id 06/23/2020, 9:20am PDT
libs get fash when their thought control bullshit runs amok, vest by saltlord 06/23/2020, 10:55am PDT
"Someone post me some quotes" KYS faggot by *nods respectfully towards you* 06/23/2020, 1:16pm PDT
cool so his patients don't deserve confidentiality because you wanna die mad by about it 06/23/2020, 3:53pm PDT
Lol I hate niggers and found Scott thru unz.com, but psychiatry is a scam NT by *nods respectfully towards you* 06/23/2020, 7:18pm PDT
running headfirst into poe's law suits you NT by stay mad 06/23/2020, 9:46pm PDT
In the current climate NT by this guy equals at least two lampsh 06/23/2020, 4:23pm PDT
Oh you think this guy didn't deserve to get doxxed? Did you know he (googling) NT by one posted about IQ/Race studies? 06/23/2020, 8:38pm PDT
"KYS faggot" by Bounty inside 06/28/2020, 7:48pm PDT
His name may be Fred Penner. I had to crawl through a hollow log to get this inf NT by Muschamp 06/28/2020, 8:31pm PDT
What a reference. I thought I imagined that show during an acid trip NT by also I have an N-word pass 06/29/2020, 12:11pm PDT
That guy's name is "Scott Siskind" NT by *nods respectfully towards you* 06/29/2020, 6:49am PDT
Came back to post and everything has been said by Vested Id 06/23/2020, 8:08pm PDT
given the rash of mysterio shitlibs we've had you can post quotes or gtfo NT by saltlord 06/23/2020, 10:46am PDT
it was a psychiatry blog by an MD from the start like the other one mentioned by Mysterio 06/23/2020, 8:43am PDT
I love it when I'm to your left and I point shit out and you cry like the infant NT by you are 06/23/2020, 10:54am PDT
Scott was originally part of the Rationalist / LessWrong crowd by blackwater 06/23/2020, 11:04am PDT
there are piles of journal articles on pubmed about genetic variation by ethnici by saltlord 06/23/2020, 1:01pm PDT
Re: there are piles of journal articles on pubmed about genetic variation by blackwater 06/24/2020, 1:12pm PDT
Re: there are piles of journal articles on pubmed about genetic variation by saltlord 06/24/2020, 2:24pm PDT
*because insurers, certifiers, boards, pharma, thought leaders, and NT by the industry are shitty to doctors 06/24/2020, 2:31pm PDT
Scott followed the research about antidepressants and wrote about it sometimes by blackwater 06/28/2020, 6:45pm PDT
Thanks, I'll give 'em a read. NT by saltlord 06/28/2020, 6:47pm PDT
I called it. by saltlord 06/28/2020, 11:22pm PDT
Can you be a little more specific about what you mean? by blackwater 06/29/2020, 4:46pm PDT
check out saltlord simping for big pharma over here. thanks saltlord! NT by Oxycontin makers 06/30/2020, 8:09am PDT
if you were any kind of serious about trolling me you'd post your hog NT by saltlord 07/08/2020, 8:56am PDT
OHHHHH SHIT HE JUST SAID POST HOG NT by Reddit Momemt 07/08/2020, 4:24pm PDT
that's where your shrill antics are from so post hog, coward NT by saltlord 07/08/2020, 9:35pm PDT
8=========D~~~~~~~~(saltlord's face) NT by owned 07/09/2020, 6:54am PDT
hog out or log out coward NT by saltlord 07/13/2020, 9:07pm PDT
is this gay nerd shit still appealing to anyone NT by ??? 02/13/2021, 5:11pm PST
and then I left my notes on a machine I was rebuilding. I'll rewrite em in a bit NT by saltlord 07/08/2020, 8:56am PDT
Toppling online statues by IPB 06/23/2020, 6:03pm PDT
Chapo Traphouse isn't anonymous and the Times still wrote a hit on them but in by saltlord 06/23/2020, 9:57pm PDT
Virgil Texas, a CTH host, was referred to by pseudonym only in their article by IPB 06/24/2020, 4:11am PDT
Virgil first went on Chapo under his real name, it's openly available to any fan by saltlord 06/24/2020, 6:42am PDT
Point is they used his pseudonym even though it was totally unnecessary NT by Vested Id 06/24/2020, 7:02am PDT
nah, that was because they did a shitty job cuz they're the failing New York Tim by saltlord 06/24/2020, 1:34pm PDT
"Hacker" "News" Has OPINIONS! by N-Gate 07/01/2020, 2:38pm PDT
Why can't i say the n-word NT by webshits 07/01/2020, 6:33pm PDT
Stuff like this reminds me of why I don't have n-gate bookmarked. by blackwater 07/03/2020, 12:23am PDT
New Yorker justifies doxxing a power nerd and remembers Gawker by IPB 07/12/2020, 11:55am PDT
Obviously it's a mitzvah to gossip like a wino spinster by The Immortal Hulk Hogan's Durag 07/12/2020, 4:42pm PDT
Awful take. Deadspin had maybe the only good writer for covering Trump by saltlord 07/13/2020, 9:23pm PDT
Why is his character vile by Well anyway 07/13/2020, 9:53pm PDT
nothing to do with capitalism, all about him specifically. look closer at him. NT by saltlord 07/15/2020, 5:46am PDT
You know well I didn't read Deadspin, brother by The Immortal Hulk Hogan's Durag 07/14/2020, 10:02pm PDT
then you missed out. failing to look closely at things gives a false sense of by understanding 07/15/2020, 6:18am PDT
Dirtsheets, brother by The Immortal Hulk Hogan's Durag 07/15/2020, 8:58pm PDT
Re: Dirtsheets, brother by Mysterio 07/16/2020, 6:44am PDT
This was me and swype, forgot my name on mobile. Also: No bet on Thiel/Google by saltphone 07/16/2020, 6:50am PDT
I'm having trouble following your argument. by blackwater 07/16/2020, 1:21pm PDT
Holy shit. by Ichabod 07/15/2020, 6:03am PDT
try me NT by trollord 07/15/2020, 6:21am PDT
Dumb Gawker/Deadspin takes START UP HERE by Get 'em while they are hot 07/16/2020, 6:30am PDT
Your response is really backing your point of view up. Are you a mensa member? NT by saltphone 07/16/2020, 6:52am PDT
The cowards did it by Vested Id 02/13/2021, 11:22am PST
But I'll still take it up the ass for the Post NT by Hush 02/13/2021, 3:28pm PST
Me? I hate the Post. NT by Vested Id 02/13/2021, 4:28pm PST
Sorry sorry NT by Hush 02/13/2021, 9:12pm PST
At least they gave him a year to prepare, so he's a lot better situated to deal NT by with it 02/13/2021, 4:50pm PST
Chin up! At least the Republicans voted against impeaching Trump NT by JUSTICE!!! 02/13/2021, 5:28pm PST
Hopefully this will be good for Scott in the long term. by blackwater 02/14/2021, 7:31pm PST
Re: Hopefully this will be good for Scott in the long term. by Hush 02/15/2021, 5:54am PST
turns out SSC was a Warren supporter so congrats MM NT by to own the cons 02/13/2021, 6:15pm PST
Huh? You think I voted for Warren? NT by MM 02/13/2021, 6:30pm PST
Nevermind, retard. I guess the point is too delicate for you to figure it out NT by Mysterio 02/13/2021, 7:43pm PST
Too many notes, dear Mozart. NT by MM 02/13/2021, 9:10pm PST
Don't blame others for your insipid post. NT by Hush 02/15/2021, 5:52am PST
|
|
| |
|
| |
